Surgical outcome after spinal fractures in patients with ankylosing spondylitis

<p>Abstract</p> <p>Background</p> <p>Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine.</p> <p>The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned.</p> <p>Methods</p> <p>Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge.</p> <p>Results</p> <p>Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries.</p> <p>Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed.</p> <p>Conclusion</p> <p>The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.</p

Serum adenosine deaminase levels in patients with brucellosis and in healthy subjects

The aim of this study was to determine the serum adenosine deaminase (ADA) levels in patients with brucellosis and compare them with the results of healthy individuals. Forty-eight subject were enrolled in this study : 34 patients with brucellosis and 14 healthy individuals. Serum ADA activity was assessed by spectrophotometer in patients with brucellosis and statistically compared with that of healthy individuals. A normal range of serum ADA was considered 5-35 IU/I. Serum ADA levels were also compared with Brucella agglutinations titers and serum C reactive protein (CRP). Serum ADA levels were found to be significantly higher in patients with brucellosis than in healthy individuals (43.45 ±24.19 IU/I and 27.5 ± 9.3 IU/I, respectively) (P < 0.01). Serum ADA activity did not show any correlation between the Brucella agglutination titer and CRP level. Serum ADA level showed significant alterations in patients with brucellosis compared to healthy subjects. We concluded that serum ADA level may be used in the follow up of patients with brucellosis together with clinical and other laboratory findings

Assessment of diagnostic enzyme-linked immunosorbent assay kit and serological markers in human brucellosis

This study was performed to evaluate commercial brucella immunoglobulin G and M-enzymelinked immunosorbent assay (IgG and IgM ELISA) kits for the diagnosis of human brucellosis and to suggest a candidate prognostic marker for human brucellosis. We determined the serum levels of brucella IgG, IgM, C-reactive protein (CRP), soluble CD14 (sCD 14), and neopterin in patients with brucellosis and compared them with those of normal healthy persons, patients with tuberculosis, and patients with other diseases. It was found that the sensitivity of ELISA to diagnose brucellosis was high when both IgG and IgM ELISA were used together. This study showed that serum CRP, sCD14, or neopterin levels were significantly high during the course of human brucellosis. The above markers, alone or in combination, might have the potential to evaluate treatment outcomes in human brucellosis. The markers that can predict the variability of agglutination titer was also determined. It was found that the titer value alone does not fully represent disease status